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February 1970

New Selective Decompression of Esophageal VaricesBy a Left Gastric Venous-Caval Shunt

Arch Surg. 1970;100(2):157-162. doi:10.1001/archsurg.1970.01340200045011

Although there is little disagreement that the portal-systemic shunt is the best treatment of variceal bleeding for patients with portal hypertension, the usual shunting methods have several post-operative problems such as Eck's syndrome or hepatic failure as a result of markedly decreased postoperative hepatic blood flow.

In countries in which the postnecrotic type of cirrhosis is most often seen, the conventional portal-systemic shunt is contraindicated for portal hypertension. Nonshunting surgical procedures have proved superior for hepatic function, but are accompanied by nutritional imbalance as well as recurrent bleeding.

In an attempt to improve these problems, we devised a controlled splenorenal shunt, which regulates the blood flow through the shunt portion. This procedure was performed with satisfactory results upon selected cases of cirrhosis. However, there are still severe types of cirrhosis which cannot benefit from controlled shunting. We have devised a new method for severe types of cirrhosis, a selective shunt.